Seminoma staging: Difference between revisions

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==Overview==
==Overview==
According to the TNM classification and stage groupings, there are 3 stages of seminoma based on the size and extent of the primary [[tumor]], number and location of any regional [[Lymph node|lymph nodes]] ([[abdominal]] [[Retroperitoneum|retroperitoneal]]) infiltrated by [[tumor]] [[Cell (biology)|cells]], distant [[metastasis]], and [[serum]] [[tumor marker]] levels.


==Staging==
==Staging==
The staging for testicular seminoma is performed according to the '''TNM system''' with staging groupings. It can be remembered in its abbreviated form as:<ref name=testiculartumorstGING1>Testicular cancer staging. Dr Marcin Czarniecki and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-cancer-staging. Accessed on February 26, 2016</ref>
*Testicular cancer may be classified into several subtypes based on the [[TNM system]] and the [[American Joint Committee on Cancer]] (AJCC).
*'''Stage I''': confined to testis, epididymis, spermatic cord, scrotum
*The [[American Joint Committee on Cancer]] (AJCC) includes serum [[tumor marker]] levels in the stages for [[germ cell tumors]]. Doctors use '''S''' to describe the levels of serum tumor markers in the blood after surgery to remove the [[testicle]]. The serum tumor markers measured are [[alpha-fetoprotein]] (AFP), [[human chorionic gonadotropin]] (HCG), and [[lactate dehydrogenase]] (LDH).<ref name="urlTesticular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/testicular/hp/testicular-treatment-pdq#_721 |title=Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
*'''Stage II''': lymph nodes involved but no distant metastases, and serum tumor markers are not very high
*'''Stage III''': distant metastases or moderately high serum tumor markers


The American Joint Committee on Cancer (AJCC) includes [[tumor marker|serum tumor marker levels]] in the stages for germ cell tumors, including seminoma. '''S''' describes the levels of serum tumour markers in the blood after [[orchiectomy]]. The serum tumor markers measured are [[AFP|alpha-fetoprotein (AFP)]], [[HCG|human chorionic gonadotropin (HCG)]], and [[LDH|lactate dehydrogenase (LDH)]].<ref name=stagingofgermcelltumors1>Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 26, 2016</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align="center"
 
| valign="top" |
{| style="border: 0px; font-size: 90%; margin: 3px; width:1000px"
|valign=top|
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|S}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| Stage}}
! style="background: #4479BA; width: 800px;" | {{fontcolor|#FFF|Serum tumor marker levels}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF| TNM/S}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF| Description}}
|-
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Stage 0
| style="padding: 5px 5px; background: #F5F5F5;" |pTis<sup>b</sup>
| style="padding: 5px 5px; background: #F5F5F5;" |Germ cell neoplasia in situ
|-
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |cNO No regional lymph node [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |N0
| style="padding: 5px 5px; background: #F5F5F5;" |pNO No regional lymph node [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |SO
| style="padding: 5px 5px; background: #F5F5F5;" |SO Marker study levels within normal limits
|-
| rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage I
| style="padding: 5px 5px; background: #F5F5F5;" |pT1
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>b</sup>
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor <3 cm in size
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup>
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor ≥3 cm in size
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT2
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT3
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT4
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor invades scrotum with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cNO
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pNO
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |MO
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]].
|-
| style="padding: 5px 5px; background: #F5F5F5;" |SX
| style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed.
|-
| rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" |Stage IA
| style="padding: 5px 5px; background: #F5F5F5;" |pT1
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>a</sup>
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor <3 cm in size
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup>
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor ≥3 cm in size
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cNO
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pNO
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |MO
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]].
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S0
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
|-
| rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage IB
| style="padding: 5px 5px; background: #F5F5F5;" |pT2
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S0
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT3
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S0
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT4
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor invades scrotum with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional [[lymph node]] [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S0
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
|-
| rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage IS
| style="padding: 5px 5px; background: #F5F5F5;" |pTX
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT0
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of primary tumor.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pTis
| style="padding: 5px 5px; background: #F5F5F5;" |Germ cell neoplasia in situ.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT1
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT1a<sup>b</sup>
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor 3 cm in size.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT1b<sup>b</sup>
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor ≥3 cm in size.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT2
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT3
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pT4
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor invades scrotum with or without lymphovascular invasion.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S1
| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>c</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S2
| style="padding: 5px 5px; background: #F5F5F5;" |LDH 1.5–10 × N<sup>c</sup> or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S3
| style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>c</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.
|-
| rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" |Stage II
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed/Marker studies not available or not performed.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN1
| style="padding: 5px 5px; background: #F5F5F5;" |Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN1
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastases.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |SX
| style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed.
|-
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIA
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed/Marker studies not available or not performed.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |SX
| style="padding: 5px 5px; background: #F5F5F5;" |cN1
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor marker levels are not available or have not been measured.
| style="padding: 5px 5px; background: #F5F5F5;" |Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align=center |S0
| style="padding: 5px 5px; background: #F5F5F5;" |pN1
| style="padding: 5px 5px; background: #F5F5F5;" |Tumor marker levels are normal.
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align=center |S1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |All tumor marker levels are above normal.
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]]
*AFP is less than 1,000 ng/mL.
*HCG is less than 5,000 mIU/mL.
*LDH is less than 1.5 times the upper limit of the normal range.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align=center|S2
| style="padding: 5px 5px; background: #F5F5F5;" |S1
| style="padding: 5px 5px; background: #F5F5F5;" |At least one [[tumor marker|tumor marker level]] is high.
| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
*[[AFP]] is between 1,000 and 10,000 ng/mL.
*[[HCG]] is between 5,000 and 50,000 mIU/mL.
*[[LDH]] is 1.5–10 times the upper limit of the normal range.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align=center|S3
| rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIB
| style="padding: 5px 5px; background: #F5F5F5;" |At least one tumor marker level is very high.
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
*AFP is higher than 10,000 ng/mL.
| style="padding: 5px 5px; background: #F5F5F5;" |See above description.
*HCG is higher than 50,000 mIU/mL.
|-
*LDH is more than 10 times the upper limit of the normal range.
| style="padding: 5px 5px; background: #F5F5F5;" |cN2
|}
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
 
|-
===TNM Classification for Seminoma===
| style="padding: 5px 5px; background: #F5F5F5;" |pN2
'''TNM''' stands for tumor, nodes, and metastasis. TNM staging describes:<ref name=testiculartumorstGING1>Testicular cancer staging. Dr Marcin Czarniecki and A.Prof Frank Gaillard et al. Radiopaedia 2016. http://radiopaedia.org/articles/testicular-cancer-staging. Accessed on February 26, 2016</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
*size and extent of the primary tumor
|-
*number and location of any regional lymph nodes (abdominal retroperitoneal nodes) infiltrated by tumor cells
| style="padding: 5px 5px; background: #F5F5F5;" |M0
*whether the cancer metastasized to distant part of the body
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastases.
 
|-
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center
| style="padding: 5px 5px; background: #F5F5F5;" |S0
|valign=top|
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
|+
|-
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|TNM Classification}}
| style="padding: 5px 5px; background: #F5F5F5;" |pT/TX
! style="background: #4479BA; width: 600px;" | {{fontcolor|#FFF|Definition}}
| style="padding: 5px 5px; background: #F5F5F5;" |See above description
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastases.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S1
| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
|-
| rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIC
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |See above description.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastases.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S0
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |See above description.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant [[metastasis]]
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S1
| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
|-
| rowspan="15" style="padding: 5px 5px; background: #DCDCDC;" |Stage III
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |See above description.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cNX
| style="padding: 5px 5px; background: #F5F5F5;" |Regional lymph nodes cannot be assessed.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN1
| style="padding: 5px 5px; background: #F5F5F5;" |Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pNX
| style="padding: 5px 5px; background: #F5F5F5;" |Regional lymph nodes cannot be assessed.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN0
| style="padding: 5px 5px; background: #F5F5F5;" |No regional lymph node metastasis.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN1
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.  
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.  
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1
| style="padding: 5px 5px; background: #F5F5F5;" |Distant metastases.  
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1a
| style="padding: 5px 5px; background: #F5F5F5;" |Nonretroperitoneal nodal or pulmonary metastases.  
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1b
| style="padding: 5px 5px; background: #F5F5F5;" |Nonpulmonary visceral metastases.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |SX
| style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed.
|-
| rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIA
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |See above description.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Any N
| style="padding: 5px 5px; background: #F5F5F5;" |See descriptions in this table, Stage III.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1a
| style="padding: 5px 5px; background: #F5F5F5;" |Nonretroperitoneal nodal or pulmonary metastases.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S0
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |See above description.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Any N
| style="padding: 5px 5px; background: #F5F5F5;" |See descriptions in this table, Stage III.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1a
| style="padding: 5px 5px; background: #F5F5F5;" |Nonretroperitoneal nodal or pulmonary metastases.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S1
| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
|-
| rowspan="13" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIB
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN1
| style="padding: 5px 5px; background: #F5F5F5;" |Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN1
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |pN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastases.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S2
| style="padding: 5px 5px; background: #F5F5F5;" |LDH 1.5–10 × N<sup>b</sup> or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Any N
| style="padding: 5px 5px; background: #F5F5F5;" |See descriptions in this table, Stage III.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |M1a
| style="padding: 5px 5px; background: #F5F5F5;" |Nonretroperitoneal nodal or pulmonary metastases.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |S2
| style="padding: 5px 5px; background: #F5F5F5;" |LDH 1.5–10 × N<sup>b</sup> or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
|-
| rowspan="21" style="padding: 5px 5px; background: #DCDCDC;" |Stage IIIC
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN1
| style="padding: 5px 5px; background: #F5F5F5;" |Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
|-
| style="padding: 5px 5px; background: #F5F5F5;" |cN2
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
|-
|-
| style="padding: 0 5px; background: #4479BA" colspan=3 |{{fontcolor|#FFF|Primary Tumor (T)}}
| style="padding: 5px 5px; background: #F5F5F5;" |cN3
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |TX
| style="padding: 5px 5px; background: #F5F5F5;" |pN1
| style="padding: 5px 5px; background: #F5F5F5;" |Primary tumor cannot be assessed ([[orchiectomy]] not performed)
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center|T0
| style="padding: 5px 5px; background: #F5F5F5;" |pN2
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of primary tumor
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |Tis
| style="padding: 5px 5px; background: #F5F5F5;" |pN3
| style="padding: 5px 5px; background: #F5F5F5;" |Intratubular germ cell neoplasia (''carcinoma in situ'')
| style="padding: 5px 5px; background: #F5F5F5;" |Metastasis with a lymph node mass >5 cm in greatest dimension.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |T1
| style="padding: 5px 5px; background: #F5F5F5;" |M0
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |No distant metastases.
Tumor limited to [[testis]] and [[epididymis]]<br>
May invade [[tunica albuginea]]<br>
May NOT invade [[tunica vaginalis]]<br>
No vascular or lymphatic invasion
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |T2
| style="padding: 5px 5px; background: #F5F5F5;" |S3
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>b</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.
Tumor limited to [[testis]] and [[epididymis]]<br>
Involvement of [[tunica vaginalis]]<br>
Vascular or lymphatic invasion
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |T3
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |Invasion of the [[spermatic cord]]
| style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |T4
| style="padding: 5px 5px; background: #F5F5F5;" |Any N
| style="padding: 5px 5px; background: #F5F5F5;" |Invasion of the [[scrotum]]
| style="padding: 5px 5px; background: #F5F5F5;" |See descriptions in this table, Stage III.
|-
|-
| style="padding: 0 5px; background: #4479BA" colspan=3 |{{fontcolor|#FFF|Regional Lymph Nodes (N)}}
| style="padding: 5px 5px; background: #F5F5F5;" |M1a
| style="padding: 5px 5px; background: #F5F5F5;" |Nonretroperitoneal nodal or pulmonary metastases.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |NX
| style="padding: 5px 5px; background: #F5F5F5;" |S3
| style="padding: 5px 5px; background: #F5F5F5;" |Regional lymph nodes cannot be assessed
| style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>b</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |N0
| style="padding: 5px 5px; background: #F5F5F5;" |Any pT/TX
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of nodal involvement
| style="padding: 5px 5px; background: #F5F5F5;" |See above descriptions.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |N1
| style="padding: 5px 5px; background: #F5F5F5;" |Any N
| style="padding: 5px 5px; background: #F5F5F5;" |One or more lymph nodes involved, but all <2 cm in greatest dimension
| style="padding: 5px 5px; background: #F5F5F5;" |See descriptions in this table, Stage III.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |N2
| style="padding: 5px 5px; background: #F5F5F5;" |M1b
| style="padding: 5px 5px; background: #F5F5F5;" |One or more lymph nodes involved 2-5 cm in greatest dimension
| style="padding: 5px 5px; background: #F5F5F5;" |Nonpulmonary visceral metastases.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |N3
| style="padding: 5px 5px; background: #F5F5F5;" |SX
| style="padding: 5px 5px; background: #F5F5F5;" |One or more lymph nodes involved >5 cm in greatest dimension
| style="padding: 5px 5px; background: #F5F5F5;" |Marker studies not available or not performed.
|-
|-
| style="padding: 0 5px; background: #4479BA" colspan=3 |{{fontcolor|#FFF| Distant Metastasis (M)}}
| style="padding: 5px 5px; background: #F5F5F5;" |S0
| style="padding: 5px 5px; background: #F5F5F5;" |Marker study levels within normal limits.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |MX
| style="padding: 5px 5px; background: #F5F5F5;" |S1
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of metastases cannot be assessed
| style="padding: 5px 5px; background: #F5F5F5;" |LDH < 1.5 × N<sup>b</sup> and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |M0
| style="padding: 5px 5px; background: #F5F5F5;" |S2
| style="padding: 5px 5px; background: #F5F5F5;" |No evidence of metastases
| style="padding: 5px 5px; background: #F5F5F5;" |DH 1.5–10 × N<sup>b</sup> or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center |M1
| style="padding: 5px 5px; background: #F5F5F5;" |S3
| style="padding: 5px 5px; background: #F5F5F5;" |Distant [[metastasis|metastases]] present
| style="padding: 5px 5px; background: #F5F5F5;" |LDH > 10 × N<sup>b</sup> or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.
*'''M1a''': non-regional lymph node OR pulmonary metastases
*'''M1b''': distant metastases not fulfilling M1a
|}
|}
===Stage Grouping for Testicular Seminoma===
Stage grouping, is based on the '''TNM system''' and '''serum tumor marker levels (S)'''.<ref name=stagingofgermcelltumors1>Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 26, 2016</ref> Each stage is given a number from 0 to 3, usually as a Roman numeral (0, I, II or III). Generally, the higher the number, the more the cancer has progressed.<ref name=stagingofgermcelltumors1>Staging testicular cancer. Canadian cancer society 2016. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/staging/?region=on. Accessed on February 26, 2016</ref>


==References==
==References==
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[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Urology]]

Latest revision as of 04:16, 29 April 2019

Seminoma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

According to the TNM classification and stage groupings, there are 3 stages of seminoma based on the size and extent of the primary tumor, number and location of any regional lymph nodes (abdominal retroperitoneal) infiltrated by tumor cells, distant metastasis, and serum tumor marker levels.

Staging
Stage TNM/S Description
Stage 0 pTisb Germ cell neoplasia in situ
N0 cNO No regional lymph node metastasis
N0 pNO No regional lymph node metastasis
M0 No distant metastasis
SO SO Marker study levels within normal limits
Stage I pT1 Tumor limited to testis (including rete testis invasion) without lymphovascular invasion.
pT1ab Tumor <3 cm in size
pT1bb Tumor ≥3 cm in size
pT2 Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion.
pT3 Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion.
pT4 Tumor invades scrotum with or without lymphovascular invasion.
cNO No regional lymph node metastasis.
pNO No regional lymph node metastasis.
MO No distant metastasis.
SX Marker studies not available or not performed.
Stage IA pT1 Tumor limited to testis (including rete testis invasion) without lymphovascular invasion.
pT1aa Tumor <3 cm in size
pT1bb Tumor ≥3 cm in size
cNO No regional lymph node metastasis.
pNO No regional lymph node metastasis.
MO No distant metastasis.
S0 Marker study levels within normal limits.
Stage IB pT2 Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion.
cN0 No regional lymph node metastasis
pN0 No regional lymph node metastasis
M0 No distant metastasis
S0 Marker study levels within normal limits.
pT3 Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion.
cN0 No regional lymph node metastasis
pN0 No regional lymph node metastasis
M0 No distant metastasis
S0 Marker study levels within normal limits.
pT4 Tumor invades scrotum with or without lymphovascular invasion.
cN0 No regional lymph node metastasis
pN0 No regional lymph node metastasis
M0 No distant metastasis
S0 Marker study levels within normal limits.
Stage IS pTX Primary tumor cannot be assessed.
pT0 No evidence of primary tumor.
pTis Germ cell neoplasia in situ.
pT1 Tumor limited to testis (including rete testis invasion) without lymphovascular invasion.
pT1ab Tumor 3 cm in size.
pT1bb Tumor ≥3 cm in size.
pT2 Tumor limited to testis (including rete testis invasion) with lymphovascular invasion OR tumor invading hilar soft tissue or epididymis or penetrating visceral mesothelial layer covering the external surface of tunica albuginea with or without lymphovascular invasion.
pT3 Tumor directly invades spermatic cord soft tissue with or without lymphovascular invasion.
pT4 Tumor invades scrotum with or without lymphovascular invasion.
cN0 No regional lymph node metastasis.
pN0 No regional lymph node metastasis.
M0 No distant metastasis
S1 LDH < 1.5 × Nc and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
S2 LDH 1.5–10 × Nc or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
S3 LDH > 10 × Nc or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.
Stage II Any pT/TX Primary tumor cannot be assessed/Marker studies not available or not performed.
cN1 Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
cN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
cN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
pN1 Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
pN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
pN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
M0 No distant metastases.
SX Marker studies not available or not performed.
Stage IIA Any pT/TX Primary tumor cannot be assessed/Marker studies not available or not performed.
cN1 Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
pN1 Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
M0 No distant metastasis
S1 LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
Stage IIB Any pT/TX See above description.
cN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
pN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
M0 No distant metastases.
S0 Marker study levels within normal limits.
pT/TX See above description
cN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
pN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
M0 No distant metastases.
S1 LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
Stage IIC Any pT/TX See above description.
cN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
pN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
M0 No distant metastases.
S0 Marker study levels within normal limits.
Any pT/TX See above description.
cN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
pN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
M0 No distant metastasis
S1 LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
Stage III Any pT/TX See above description.
cNX Regional lymph nodes cannot be assessed.
cN0 No regional lymph node metastasis.
cN1 Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
cN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
cN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
pNX Regional lymph nodes cannot be assessed.
pN0 No regional lymph node metastasis.
pN1 Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
pN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
pN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
M1 Distant metastases.
M1a Nonretroperitoneal nodal or pulmonary metastases.
M1b Nonpulmonary visceral metastases.
SX Marker studies not available or not performed.
Stage IIIA Any pT/TX See above description.
Any N See descriptions in this table, Stage III.
M1a Nonretroperitoneal nodal or pulmonary metastases.
S0 Marker study levels within normal limits.
Any pT/TX See above description.
Any N See descriptions in this table, Stage III.
M1a Nonretroperitoneal nodal or pulmonary metastases.
S1 LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
Stage IIIB Any pT/TX See above descriptions
cN1 Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
cN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
cN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
pN1 Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
pN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
pN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
M0 No distant metastases.
S2 LDH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
Any pT/TX See above descriptions
Any N See descriptions in this table, Stage III.
M1a Nonretroperitoneal nodal or pulmonary metastases.
S2 LDH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
Stage IIIC Any pT/TX See above descriptions.
cN1 Metastases with a lymph node mass ≤2 cm in greatest dimension OR multiple lymph nodes, none >2 cm in greatest dimension.
cN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension OR multiple lymph nodes, any one mass >2 cm but ≤5 cm in greatest dimension.
cN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
pN1 Metastasis with a lymph node mass ≤2 cm in greatest dimension and ≤5 nodes positive, none >2 cm in greatest dimension.
pN2 Metastasis with a lymph node mass >2 cm but ≤5 cm in greatest dimension; or >5 nodes positive, none >5 cm; or evidence of extranodal extension of tumor.
pN3 Metastasis with a lymph node mass >5 cm in greatest dimension.
M0 No distant metastases.
S3 LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.
Any pT/TX See above descriptions.
Any N See descriptions in this table, Stage III.
M1a Nonretroperitoneal nodal or pulmonary metastases.
S3 LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.
Any pT/TX See above descriptions.
Any N See descriptions in this table, Stage III.
M1b Nonpulmonary visceral metastases.
SX Marker studies not available or not performed.
S0 Marker study levels within normal limits.
S1 LDH < 1.5 × Nb and hCG (mIU/mL) <5,000 and AFP (ng/mL) <1,000.
S2 DH 1.5–10 × Nb or hCG (mIU/mL) 5,000–50,000 or AFP (ng/mL) 1,000–10,000.
S3 LDH > 10 × Nb or hCG (mIU/mL) >50,000 or AFP (ng/mL) >10,000.

References

  1. ↑ "Testicular Cancer Treatment (PDQ®)—Health Professional Version - National Cancer Institute".

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